Infection Control Flashcards
1
Q
What are Pathogens?
A
disease producing microorganisms
2
Q
What are microbes called that are beneficial?
A
Probiotics
3
Q
What life form is included in microbiology?
A
bacteria, small fungi (molds and yeast), protozoa, certain algae, and viruses.
4
Q
infection control goals
A
Goal 1 Understanding properties of microorganisms Goal 2 Understand how microorganisms cause specific diseases How to kill the microorganisms Goal 3 Preventing disease Preventing spread from person to person
5
Q
Coccus/Cocci:
A
Spherical
6
Q
Bacillus/Bacilli:
A
Rod-shaped
7
Q
Spirillum/Spirilla:
A
Curved or spiral cells
8
Q
Disease transmitted in Dental Office
A
influenza
9
Q
Blood-borne diseases
A
Hepatitis B and AIDS
10
Q
Diseases elsewhere in body
A
Measles
11
Q
Specific oral diseases
A
Herpes infections
12
Q
Fungi includes
A
mushrooms, molds, and yeast
13
Q
Candidiasis :
A
Yeast infection
-Thrush
Candida albicans
14
Q
what scrapes off easily
A
yeast infection
15
Q
what doesn’t scrape off
A
lucoplaycia
which is also an autoimmune response
16
Q
the category of bacteria on the hands that refers to the normal skin bacteria rather than the pathogens is called?
A
Resident
17
Q
what describes the transient skin flora on the hands
A
microbes that are usually involved in the spread of disease from the hands
18
Q
wearing gloves at chair side helps prevent which of the following routes of entry of patients microbes into the body?
A
percutaneous
19
Q
mycology is the study of
A
fungi
20
Q
infection control is
A
controlling microbial contamination and infection
21
Q
pasteurization is achieved by…
A
heating a fluid to 63’C(145’F) for 30 mins
22
Q
viruses that infect bacteria…
A
bacteriophage
23
Q
which agent can cause prion disease
A
special proteins
24
Q
Bloodborne Pathogens
includes blood borne diseases
- hepatitis infections
- tuberculosis
- hiv/aids
A
may infect different blood cells or other tissues of the body, but during infection the pathogens exit in or are released into the blood or other body fluids.
25
Hepatitis A –
Infectious hepatitis
26
Hepatitis B
– Serum Hepatitis
27
Hepatitis C –
Non A Non B
28
Hepatitis D –
Delta Virus
29
Hepatitis E –
Enteric
30
Hepatitis G – (HGV) transmitted via blood
transmitted via blood
31
Fluids where bloodborne pathogens can be released include:
```
Semen
Vaginal secretion
Intestinal secretions
Tears
Mother’s milk
Synovial (joint) fluid,
Pericardial (around the heart)fluid
Amniotic fluid (around the developing fetus
Saliva
```
32
which hepatitis is the main concern for health care workers
Hep B
33
Hepatitis B (HBV)
It’s an enveloped DNA virus that infects and multiplies in human liver cells
A milliliter of blood can contain as many as 100 million virus particles
Only a small amount is required to transmit disease
34
Three components of Hep B
HBsAg: Hepatitis B Surface Antigen
HBcAg: Hepatitis B Core Antigen
HBeAg: Hepatitis Be Antigen
35
How are HBV vaccines made
from the surface antigen
36
Hepatitis B (HBV)
Can remain viable at room temperature for at least 1 month
Can be killed or inactivated
HBV is more easily killed than Mycobacterium tuberculosis and bacterial spores
37
Can be killed or inactivated by
sterilization: steam autoclave
```
Disinfection:
10 min. exposure to 1:100 diluted bleach
1:16 diluted phenolic glutaraldehyde
75 parts per million (ppm) iodophor
70% isopropyl alcohol
```
38
Disease States
90% of people infected with HBV will have complete recovery without developing a carrier state
39
Carrier State:
being HBsAg-positive on at lease two occasions when tested
Has potential for spreading disease to others
40
HBV is spread
Percutaneously (through the skin)
Permucosally (through muchous membranes)
Perinatal ( during child birth)
41
High Risk Behaviors for Acquiring HBV
Sharing contaminated needles
Sexual intercourse with an infected person w/o using a condom
Becoming pregnant while infected with HBV
42
HBV being spread through transfusion is...
rare
43
Fecal-oral route does ...
not commonly occur
44
No transmission occurs through
Tears
Sweat
Urine
Droplet infection
45
Symptoms of HBV
```
Appears 45 to 180 days after exposure
Yellowing of the skin(Jaundice)
Yellowing of the whites of the eyes
Light colored stools
Dark urine
Joint pain
Fever, rash, itching
Malaise (not feeling well)
```
46
Risk for Dental Team
Unvaccinated members 2 to 5 times more likely to become infected
Injuries from contaminated sharps
Blood and saliva contamination
Spraying of blood and saliva into open lesions on skin or onto mucous membranes
47
OSHA Blood-Borne Pathogens Standard
is the most important infection control law in dentistry
It is designed to protect the employees against occupational exposure to blood-borne disease causing organisms i.e. HBV, HCV, and HIV
Requires employers to protect employees from blood and OPIM
48
Exposure Control Plan
Every dental office must have a written exposure control plan that clearly describes how the office complies with the BBP Standard
Must be reviewed and updated annually
Every dental office must have a written hazard communication program
49
Categories of Employees
OSHA BBP Standard requires employers to categorize tasks and procedures during which an employee may be occupationally exposed.
Occupational exposure
50
Occupational exposure
Any reasonably anticipated skin, eye, mucous membrane contact, percutaneous injury with blood of OPIM
51
Category I of employees
Routinely exposed to blood saliva or both
Dentist, dental assistant, dental hygienist, laboratory technician
52
Category II of employees
May on occasion be exposed to blood, saliva or both
Receptionist, office manager who may clean rooms
53
Category III of employees
Never exposed to blood saliva, or both
| -Financial manager, insurance clerk, computer operator
54
Post-exposure Management
If an incident occurs:
BBP Standard requires the employer to have a written plan
Plan explains exactly what steps the employee must take
The employer must provide training to employees on the proper response to an exposure incident
55
BBP Standard requires
the dentist/employer to provide training in infection control procedures and safety issues to all personnel who may come into contact with blood, saliva or OPIM
56
Employer must keep record of training
Date
Topic
Names of all who attended
57
Employee Medical Records
The dentist/employer must keep a confidential medical record for each employee
Records stored in locked file
Must be maintained for duration of employment plus 30 years
58
Classification of Waste
OSHA regulations apply to the handling of waste in the dental office for the protection of employees.
EPA regulations apply for waste when it leaves the office, and to its disposal
59
All dental waste should be classified according to EPA guidelines as
Regulated
| Non-regulated
60
Regulated waste includes:
Sharps (EPA classified Infectious waste)
Blood
Extracted teeth
Toxic waste
require special disposal
61
Sharps (EPA classified Infectious waste)
Disposable needles, scalpel blades, contaminated broken glass, disposable dental burs, endodontic files and reamers, and orthodontic wire
62
Blood
, blood-soaked and blood-caked items, human tissue, and pathologic waste
63
Toxic waste:
can have a poisonous effect
| Must be labeled with biohazard symbol
64
Biohazard Warning Label
Fluorescent orange or red orange
Biohazard symbol
Word biohazard attached to
- Regulated waste
- Refrigerators or freezers containing blood or OPIM
65
Non-regulated waste includes:
Contaminated waste materials i.e.
Saliva soaked gauze
Used patient bibs
Surface barriers
66
All waste containers that hold potentially infectious materials (whether regulated or non-regulated) must be labeled with the ____ ____
biohazard symbol.
67
non regulated waste
general
68
medical waste (regulated)
contaminated and infectious
69
chemical waste (regulated)
hazardous and toxic
70
Handling Hazardous Materials
Materials would include, but are not limited to:
```
Outdated x-ray solutions
Vapor sterile
Lead foil from x-ray packets
Scrap amalgam/mercury
Glutaraldehyde solution with concentration higher the 2%
```
71
Preventing Sharps Injury by establishing a “Culture of Safety”
Culture refers to factors that influence overall attitudes and behavior in the office
A Safety Culture reflects the shared commitment of the employer & employees toward ensuring the safety of the work environment.
72
Safety Syringes
included in the changes in the Engineering Controls to include devices which are engineered with injury protection and needleless systems
73
Disinfection
Eliminates many or all pathogenic microorganisms, with the exception of bacterial spores
74
Sterilization
Complete elimination or destruction of all forms of microbial life including bacterial spores
75
Asepsis
Prevention of contact from pathogens:
-Includes disinfection, sterilization and all other measures
76
Antiseptic
Germicide used on skin or living tissue for the purpose of inhibiting or destroying microorganisms
77
Classification of Patient Care Items
Based upon the risk of transmitting infection if the item becomes contaminated during use
78
Instruments are Classified as:
Critical
Semi-critical
Non-critical
79
Mandates of Sterilized Items
CDC, ADA and OSAP mandated that all critical and semi-critical dental instruments that are heat stable be sterilized by:
Autoclaving: steam under pressure
Dry Heat
Chemical Vapor
80
Critical Items
Instruments used to perform invasive procedures
Come in direct contact with soft or bony tissues
Can cut or penetrate tissue
81
critical items must be ____ sterilized
heat
82
examples of heat sterilized instruments
explores, scalpels, surgical forceps, bone chisels
| Handpieces, manual cutting instruments, burs
83
Semi-Critical
Instruments not intended to penetrate oral soft or hard tissues but may come into contact with oral tissue
Instruments should be heat sterilized when possible
Can use high-level disinfectant
84
what is a high level disinfectant
(Glutaraldehyde) – chemical disinfectant that is used as a cold sterile for items that cant withstand heat
85
semi-critical instruments include
Amalgam condensers, amalgam carriers, plastic instruments
| Dental dam frame, mouth mirrors
86
Non-critical Items
Instruments that do not come into direct contact with body fluids
May contact intact skin or working surfaces
Not used directly in the mouth
87
non-critical items include
Medicament jars, cavity liners, unit tubing, restorative materials, positioning device to x-ray machine, blood pressure cuff, stethoscope
88
noncritical items Items should be sanitized or cleaned using an intermediate or low-level disinfectant
bleach and water
89
Seven Steps for Instrument Processing
1. holding (presoaking)
2. pre cleaning
3. Corrosion Control, drying, lubrication
4. packaging
5. Sterilization or high level disinfection
6. Sterilization monitoring
7. Handling processed instruments
90
Holding (Presoaking)
Facilitates the cleaning process by preventing debris from drying.
91
Precleaning
Removes as much of the bioburden as possible to give the subsequent sterilization step the best chance to work . Which types? Blood, saliva, tissue
92
Corrosion Control, drying, lubrication
Reduces damage to instruments and helps ensure proper functioning of the instruments
93
Packaging
Helps maintain sterility of instruments after sterilization and before they are presented to a patient
94
Sterilization or high level disinfection
Kills all microbes remaining on the instruments to help ensure patient safety.
95
Sterilization monitoring
Measures the use and functioning of the sterilizer
96
Handling processed instruments
Helps maintain the sterility of the instruments during storage until they are used on a patient
97
what are some Hands free Mechanical Devices
ultrasonic cleaners and automatic washers/disinfectants
98
Ultrasonic Cleaners
Loosen and remove debris from instruments
Reduce risk of hand injury
Puncture resistant utility gloves and PPE used
Works by production of sound waves through cavitation and implosion of bubbles
99
Automatic Washers/Disinfectors
FDA approved appliance
Classified as thermal disinfectors
Subjects instruments to level of heat that kills most vegetative microorganisms
100
Steam Autoclave
Used to sterilize dental instruments
Uses steam and pressure
Operates through four cycles
101
4 cycles of the steam autoclave
```
Heat-up cycle
Sterilizing cycle
-2500 F (1210 C) for 30 minutes
Depressurization cycle
Also known as the vent cycle
Drying cycle
```
102
advantages of the steam autoclave
Short time
No corrosion
Instruments dry quickly following cycle
103
disadvantages of the steam autoclave
Damages some plastic and rubber items
Requires use of distilled water
May rust non-stainless steel instruments and burs
Cannot use closed containers
104
STAT/M Sterilizer
“Flash” Sterilization of unpackaged instruments using short exposure times. (2730 F for 3 minutes)
105
Sterilization Failures
```
Inadequate Instrument Cleaning
Improper packaging
Improper loading of sterilizer
Improper timing
Improper temperature
Improper Method of Sterilization
```
106
Sterilization Monitoring
Mechanical (Physical) Monitoring
Chemical Monitoring
Biologic Monitoring
107
Biologic Monitoring
Also known as spore testing
Determines if endospores have been killed
Provides the main guarantee of sterilization
108
Chemical Monitoring
Process indicators (external)
Located on outside of instrument packs
Identify instrument packs exposed to certain temperatures
Also known as single-parameter indicators
Indicates processed vs. unprocessed packs
109
Mechanical (Physical) Monitoring
Looking at gauges and readings on sterilizer
| Recording temperatures, pressure, exposure time
110
```
Chemical Monitoring,
Process Integrators (internal)
```
Placed inside the instrument packages
They respond to a combination of pressure, temperature and time
Also known as multi-parameter indicators
All sterilization factors are integrated
Includes: strips, tabs and tubes of colored liquid
111
Integrator Strips
Used inside packs to monitor time, temperature and pressure
112
Biologic Monitoring
The CDC, ADA and OSAP recommend at least weekly biologic monitoring of sterilization equipment.
Biologic indicators (BIs) are also known as spore test
can be vials or strips of paper containing harmless bacterial spores
113
high speed handpiece runs at
400,000rpm
114
Blood, saliva and tooth fragments can lodge in heads
| Dental handpieces must be properly cleaned and heat-sterilized by
flushing and sterilization techniques
115
Flushing Techniques
Attach to pressurized handpiece cleaner
Blow out using compressed air
Flush for approximately 25 sec. at end of each appointment
116
Sterilization Techniques
Steam are chemical vapor sterilization recommended
Packaged in bags, wraps or packs
Temperatures should not exceed 2750F (1350C)
Never run HP “hot” or cool down with water
117
Sterilization of Heat-Labile Items
Reusable items that cannot withstand heat sterilization
Liquid sterilant/high-level disinfectant
118
Reusable items that cannot withstand heat sterilization:
Examples
Some plastics, dental dam frames, shade guides, rulers, x-ray collimating devices
119
Liquid sterilant/high-level disinfectant
2.0% - 3.4% Glutaraldehyde
or
7.0% Hydrogen peroxide
Requires 3-12 hour contact time
Glutaraldehyde requires 10-hr contact time
120
Disadvantage of Sterilization of Heat-Labile Items
No way to perform biological monitoring
121
1/3 of those infected with ___ have recognizable symptoms
Hep B
122
safety data sheet
describes the properties and potential hazards of chemicals
123
which is not considered as regulated waste in dentistry?
a) extracted teeth
b) used face mask
c) non sharp solids
d) sharps contaminated with blood or saliva
b) used face mask
124
which is considered regulated waste?
a) used plastic surface barrier
b) used sterilization wrap
c) used scalpel blade
d) cotton roll damp with saliva
used scalpel blade
125
which is regulated waste in a dental office?
a) used patient bib
b) a 2x2 gauze pad with drops of blood
c) double ended scaler with broken tip
d) used exam gloves
double ended scaler with broken tip
126
OSHA requires sharps container to be?
a) made of glass
b) leak proof
c) reusable
d) securely attached to a wall
leak proof
127
sharps containers should have which of the following properties?
a) be made of glass
b) clear, see through plastic
c) reusable after contents are emptied
d) be made to be closed
be made to be closed
128
which can be thrown in the regular trash even if its contaminated with a little saliva?
a) broken anesthetic carpules
b) injection needles
c) cotton rolls
d) burs
cotton rolls
129
most regulated medical waste in dental office consists of?
a) liquid blood and contaminated sharps
b) contaminated sharps and extracted teeth
c) non liquid solids saturated with blood or saliva and extracted teeth
d) non liquid solids saturated with blood or saliva and liquid saliva
contaminated sharps and extracted teeth
130
what the best way to dispose of a contaminated needle?
a) pass it to someone else for disposal
b) cut the needle and place it in sharps container
c) place the needle in sharps container as soon as possible
d) bend the needle and place in sharps container
place the need in sharps container as soon as possible
131
which should be done before disposing of a used anesthetic needle?
a) bend the needle
b) pass to someone else for recapping
c) recap needle by hand
d) recap the needle with scoop technique
recap with scoop technique
132
how to do you pick up a dropped anesthetic needle on the floor with a patient?
a) pick it up and place on instrument tray
b) put on utility gloves, pick it up and place in sharps
c) use tongs or cotton pliers to pick it up and place on instrument tray
d) use tongs or cotton pliers to pick up and place in sharps
use tongs or pliers to pick up and place in sharps
133
sharp containers should be?
a) occasionally drained to remove any liquid
b) filled only 3/4 full before disposing
c) emptied and reused
d) kept in sterilizing room
filled 3/4 full before disposing
134
when could a sharps injury most likely occur?
a) cleaning and disinfecting a counter top
b) operating the dry heat sterilizer
c) using a biological indicator
d) inserting a bur into handpiece
inserting a bur into a handpiece
135
when could a sharps injury most likely occur?
a) operating the autoclave
b) cleaning and disinfecting a counter to
c) handling sterile packs of hand instruments
d) using a biological indicator
handling sterile packs of hand instruments
136
when could a sharps injury most likely occur?
a) placing patient bib
b) using a biological indicator
c) hand instruments are placed back into instrument tray
d) using the HVE
hand instruments are placed back into instrument tray
137
what is engineering control?
a devise that removes the potential hazard
138
what is work place control?
an action that alters the manner in which a task is performed
139
what is the safest approach to cleaning and managing contaminated hand instruments ?
- ultrasonic cleaning in instrument casset
- hand scrubbing
- ultrasonic cleaning in cleaning basket
ultrasonic cleaning in instrument casset
140
employees who are routinely exposed to blood and OPIM are placed in the following category?
I
II
III
IV
category I
141
what does OPIM mean
other potentially infectious materials
142
the goal of the ___ ___ ____ is to ensure employees and employers know about work hazard and how to protect themselves
- hazard communication program
- work practice control
- exposure control plan
- hazard communication program
143
the main directive of OSHA is protect who?
the employee
144
containers that are received from the MANUFACTURER ____ need to be relabeled?
does not
145
waste that leaves the dental office is regulated by?
- OSHA
- EPA
- OSAP
- CDC
OSHA
146
which microbes are not killed by intermediate level disinfectants?
- bacterial spores
- tuberculosis agent
- neither
- both
both
- bacterial spores
- tuberculosis agent
147
what antimicrobials agents can be used on the floor
low level disinfectant
148
what antimicrobial agents should not be used for surface disinfection in dentistry?
sterilant/ high level disinfectant
low level disinfectant
intermediate level
sterilant/ high level disinfectant
149
what agent is not tuberculocidal
phenolic
glutaraldehyde
iodophor
windex
windex
150
why should disinfectants used on clinical contact surfaces contaminated with blood or saliva have tuberculodial activity?
bc the tuberculosis agent is one of the more resistant microbes to kill. tuberculocidal activity indicates sufficient potency to kill most other negative microbes
151
liquid sterilants, gluteraldehyde, should be used only on reusable items that can be submerged and are?
heat sensitize
152
the use of a disenfectant type cleaner to pre clean a contaminated operator surface:
- starts the microbial killing process and helps protect the person doing the cleaning
- should not be done
- is necessary overtime a surface cover is removed
- eliminates the need to followup with a disenfectant wipe
-starts the microbial killing process and helps protect the person doing the cleaning
153
when can a liquid sterilant achieve sterilization
- sterilization will only occur when the solution is used only for the longer exposure time
- sterilization will only occur when the solution is used at a temperature about 121'C/ 250'F
-sterilization will only occur when the solution is used only for the longer exposure time
154
touch surfaces are ...
- used minimally throughout the procedure
- used continually thoughout the procedure
- are never touched
-used minimally throughout the procedure
155
glutaraldehyde is a _____ level disenfectant/sterilant
high
156
high level sterilants take _ hours to sterilize an instrument
6-10 hours
157
a hospital level disinfectant will...
inactivate the polio 2 and tuberculosis bacteria
158
how do you sterilize a rubber dam
a liquid sterilant aka gluteraldehyde
159
the purpose of the aluminum foil test is to
determine whether an ultrasonic cleaner chamber has an even distribution of sonic energy
160
the ultrasonic cleaner works by
sound waves and implosion
161
kitchen dishwasher cannot be used to pre clean bc they are not ____ approved
FDA
162
the temp recommend for the steam autoclave is
250 degrees for 30 minutes
163
where is the process indicator placed
outside the package
164
another term for spore testing is
biologic monitoring
165
what kind of heat sterilization is appropriate for high speed handpieces
steam and chemical vapor
166
process integrators are also knows as
combination indicators
167
in flash autoclaves unpackaged instruments can be processed using short exposure times at...
273 degrees for 3 minutes
168
microbes spreading from a patients mouth to your hand and then to another patients mouth represents what type of spread from patient to patient
indirect contact
169
during development of an infectious disease what should happen before the step ' spread to a new host'
escape from current source
170
the incubation stage of an infectious disease occurs
after contamination and before symptoms
171
infection is best described as
growth and survival of microbes on or in the body
172
what bacterial structure protect the cell from being crushed
cell wall
173
bacteria that can survive and grow in the presence of acids are call
aciduric
174
bacteria that die in the presence of oxygen are called
anaerobic
